Does a patient with memory changes and carotid duplex scan findings of smooth plaque formation in the mid right Common Carotid Artery (CCA) and minimal intimal thickening in the carotid bulbs and Internal Carotid Arteries (ICAs) bilaterally require follow-up?

From the Guidelines

No immediate follow-up is needed for the carotid arteries based on the provided carotid duplex findings, as the study shows no hemodynamically significant narrowing and the velocity measurements and ICA/CCA ratios are within normal limits 1. The carotid duplex ultrasonography was performed due to memory changes, but the findings do not explain the cognitive symptoms, as there is no evidence of significant vascular compromise that would affect brain perfusion. The study shows only minimal plaque formation in the right common carotid artery and minimal intimal thickening in the carotid bulbs and internal carotid arteries bilaterally. The vertebral arteries show normal antegrade flow, and the subclavian arteries demonstrate normal triphasic waveforms. The velocity measurements and ICA/CCA ratios (0.8 on right, 0.9 on left) are within normal limits, indicating no significant stenosis. According to the 2025 clinical consensus statement on stroke risk management in carotid atherosclerotic disease, routine surveillance is not recommended for all patients after carotid revascularization, but rather based on individual risk factors and clinical presentation 1. The patient should continue with regular cardiovascular risk factor management, but specific follow-up for the carotid arteries is not necessary unless new neurological symptoms develop or as part of routine vascular screening based on the patient's overall cardiovascular risk profile. It is essential to note that the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease recommends carotid duplex ultrasonography for patients with nonspecific neurological symptoms when cerebral ischemia is a plausible cause, but the current findings do not indicate a need for immediate follow-up 1.

From the Research

Carotid Duplex Scan Findings

• The carotid duplex scan revealed smooth plaque formation in the mid right common carotid artery (CCa) with minimal intimal thickening in the carotid bulbs and internal carotid arteries (ICAs) bilaterally.
• Antegrade flow was present in the vertebral arteries, and triphasic waveforms were present in the subclavian arteries.
• The peak systolic velocities and end diastolic velocities in the ICAs were below the threshold values for significant stenosis, as defined by 2.

Diagnostic Criteria

• According to 2, a peak systolic velocity of 230 cm/s or more, an end diastolic velocity of 70 cm/s or more, or an internal carotid artery:common carotid artery ratio of 3.2 or more is indicative of 70% or more stenosis.
• In this case, the peak systolic velocities and end diastolic velocities in the ICAs were below these threshold values, suggesting no significant stenosis.

Follow-up

• Given the absence of hemodynamically significant narrowing in the extracranial carotid arteries, as indicated by the duplex scan findings, follow-up may not be necessary unless symptoms persist or worsen 3, 4.
• However, the decision to follow up should be based on individual patient factors, such as the presence of risk factors for carotid disease, as discussed in 5.

Diagnostic Accuracy

• The diagnostic accuracy of duplex ultrasound for carotid artery stenosis is high, especially for detecting significant stenosis, as shown in 4.
• The use of duplex ultrasound as a single diagnostic test before carotid revascularization is supported by its high accuracy and less invasive nature 4.